Failure to Provide PRN Pain Management During Care and Wound Treatment
Penalty
Summary
The deficiency involves the facility’s failure to provide safe and appropriate pain management for residents who required such services, specifically affecting two residents reviewed for pain management. One resident was admitted with hemiplegia, hemiparesis, muscle weakness, abnormal gait, cognitive communication deficit, dysphagia, and abnormal posture. His care plan, initiated in December and updated in January, included participation in a personal pain management program, education on pain management including non-pharmacological approaches, and pain management as needed. An order was in place for acetaminophen 325 mg, two tablets by mouth every four hours as needed for mild pain. On one observed day, this resident reported back pain and an inability to move his right arm while lying in bed. Shortly afterward, a CNA provided incontinence care and lifted the resident’s right arm to change his shirt, during which the resident hollered, moaned, and stated that his right arm hurt. The CNA apologized and continued care, removing the resident’s soiled incontinence brief. The resident’s perineal area was noted to be very reddened, and when the CNA wiped the area with a towel, the resident moaned, moved side to side, and complained that his perineal area hurt. The Medication Administration Record for that day shows the resident did not receive any pain medication, although he did receive pain medication the following day for pain rated 7 out of 10. The second resident involved was admitted with diagnoses including a right pubis fracture, malignant neoplasm of the bladder, major depressive disorder, right hip pain, anxiety disorder, and osteoarthritis. Orders were in place for acetaminophen 325 mg, two tablets by mouth every six hours as needed for pain, and hydromorphone 0.5 ml by mouth every eight hours as needed for pain. During an observed peri-care episode, CNAs removed the resident’s incontinence brief and noted a moderate amount of blood, believed to be from the rectum. When asked about pain, the resident patted her abdomen. The resident had two urinary drainage bags from the back area and a large, uncovered sacral wound. During wound care by an LPN/Wound Care Nurse, the resident tensed and moaned, and when asked afterward if the sacral area hurt, she nodded yes. When her right lower extremity was lifted, she said “Ow.” The Medication Administration Record for the month shows she had received acetaminophen and hydromorphone on earlier dates for high pain scores but did not receive any pain medication on the day of the observed pain behaviors, despite the facility’s pain management policy emphasizing recognition, management, and monitoring of residents’ pain.
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